Basic Information
| Provider Information | |||||||||
| NPI: | 1346389251 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHOPEDIC SURGICAL CONSULTANTS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2854 HIGHWAY 55 | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551212156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518423367 | ||||||||
| FaxNumber: | 6512245273 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 SAINT FRANCIS AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553793373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524033399 | ||||||||
| FaxNumber: | 9524033390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 09/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | LARSON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PA-C, OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9524033399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.